1. Hip and Knee Arthritis and Joint Replacement
Barton Harris, MD

2. Barton Harris, MD Orthopaedic Surgeon
Fellowship-Trained in Adult Reconstruction (Joint Replacement)

3. “It would be embarrassing to get out of a car because everybody had to help me. Somebody would have to pull me up. I felt like this old woman.”
“My life got progressively less active, less fun, and less participative.”
“Just a day on my feet was exhausting and the pain became greater and greater until Advil and ibuprofen and all of those kinds of drugs couldn't numb it out. It just got worse and worse.”
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4. You’re Not Alone…
More than 43 million people have some form of arthritis.
It is estimated that the number of people affected by arthritis will increase to 60 million by 2020.
Source: CDC

5. This program will touch upon the following topics:
Understanding the Causes of Joint Pain
Treatment Options
What Joint Replacement Surgery Involves
Realistic Expectations After Joint Replacement

6. Did you know?
Nearly 21 million Americans suffer from osteoarthritis, a degenerative joint disease that is a leading cause of joint replacement surgery.
Add a new slide with images of daily tasks – stairs, gardening, getting out a car, etc.
Source:

7. Most Common Types of Arthritis
Osteoarthritis
Rheumatoid Arthritis
Post-traumatic Arthritis
Avascular Necrosis

8. OA Symptoms May develop suddenly or very slowly
Arthritis can cause pain and stiffness
Some types of arthritis may cause swelling
Simple tasks may be difficult to do

9. Other Conditions Rheumatoid Arthritis Post-traumatic Arthritis
Membranes or tissues lining the joint become inflamed
Post-traumatic Arthritis
Irregularities lead to more wear on the joint
Avascular Necrosis
Bone may collapse and damage cartilage
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10. Rheumatoid Arthritis One of the most crippling form of arthritis:
affects approximately 2.1 million Americans
two to three times more women than men
average onset for rheumatoid arthritis is between the ages of 20 and 45 years old
Source: CDC

11. Joint Degeneration Pain from arthritis and joint degeneration can:
Be constant or come and go
Occur with movement or after a period of rest
Be located in one spot or in many parts of the body
Be worse during certain times of the day or during certain activities

12. Joint Degeneration Interference With Daily Activities…
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17. Preparing for your Doctor’s Visit
The Orthopaedic Evaluation
A thorough medical history
A physical examination
X-rays
Additional tests, as needed

18. The Orthopaedic Evaluation: What YOU should bring…
A list of all medications / dosages you are currently taking
Information on prior surgeries and/or treatments (medication, PT, injections)
Copies of X-rays, MRI or reports
Prior diagnoses
Family history

19. The Orthopaedic Evaluation
The physical examination enables your surgeon to evaluate important aspects of your joints, including:
Size and length
Strength
Range of motion
Swelling
Reflexes
Skin condition

20. The Orthopaedic Evaluation X-ray Evaluation
An abnormal X-ray may reveal:
Narrowing of the joint space
Cysts in the bone
Spurs on the edge of the bone
Areas of bony thickening called sclerosis
Deformity or incorrect alignment

21. Normal Knee X-ray
Arthritic Knee X-ray

22. Normal Hip X-ray
Arthritic Hip X-ray

23. The Orthopaedic Evaluation
Additional Diagnostic Tests may include:
Blood tests
Urine analysis
Analysis of joint fluid
Magnetic Resonance Imaging (MRI)
Bone scan

24. Treatment Options Medications Physical therapy Bracing
Injections (steroid or joint fluid supplements)
Arthroscopy – cleaning the joint
Partial joint replacement
Total joint replacement

25. Medications Aspirin-free pain relievers–acetaminophen
Nonsteroidal anti-inflammatories (NSAIDs)
Glucosamine / chondroitin sulfate
Corticosteroids–injection/pill form
Quick, effective pain relief
Max 3-4 times per year
Viscosupplementation = Joint Fluid Replacement

26. Bracing and Assistive Devices
A cane in the opposite hand decreases joint forces by 50% !
“Unloader” braces can take pressure off the painful side of the knee and stabilize the joint

27. Physical Therapy Passive range-of-motion exercises may help:
Reduce stiffness
Keep joints flexible
4-5 times bodyweight through knee climbing stairs!
Quadriceps strengthening
Transition from high to low-impact exercises
Cycling, elliptical, swimming
Avoid deep knee bends against resistance

28. What is Arthroscopy?
Arthroscopy is a surgical procedure used to visualize, diagnose and treat problems inside a joint.
A small incision is made in the patient's skin and then pencil-sized instruments are inserted that contain a small lens and lighting system to magnify and illuminate the structures inside the joint.

29. Partial Joint Replacement
Surgical procedure in which only the damaged or diseased surfaces of the joint are replaced, leaving much of the natural bone and soft tissue in place.
Post-operative pain may be reduced
Recovery period may be shorter than total knee replacement

30. Total Joint Replacement
Surgical procedure in which certain parts of an arthritic or damaged joint are removed and replaced with an artificial joint.
The artificial joint is designed to move just like a healthy joint.

31. Joint Replacement Joint replacement is a treatment option when pain:
Is severe
Interferes with daily activities
Interferes with work

32. Joint Replacement
Joint replacement is a decision that should include:
You
Your primary care provider
Your orthopaedic surgeon

33. Did you know?
Total joint replacements of the hip and knee have been performed since the 1960s.
Today, these procedures have been found to result in significant restoration of function and reduction of pain in 90% to 95% of patients.
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Source: National Development Conference, National Institutes of Health, December 2003

34. Joint Surgery May be suitable for patients who:
Have a painful, disabling joint disease of the joint resulting from a severe form of arthritis
Are not likely to achieve satisfactory results from less invasive procedures, medication, physical therapy, or joint fluid supplements
Have bone stock that is of poor quality or inadequate or other reconstructive techniques

35. Joint Replacement: Preoperative
Preparing begins weeks before the actual day of surgery!
In general, patients may need:
Routine blood tests
Urinalysis
Physical examination
Exercise
Quit smoking
Stop certain medications
Classroom preparation

36. Total Joint Replacement
Goals of total joint replacement are to help:
Relieve pain
Restore motion and function

37. Prevalence…
More than 300,000 knee replacements are performed each year in the US.1
More than 300,000 hip replacements are performed in the United States each year.2
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38. Total Joint replacement – Where? And Who?
These are my personal recommendations…
Somewhere with a comprehensive program
Adequate resources for patient’s post-op care
A surgeon the patient is comfortable with
An “experienced” surgeon

39. Your Hip Joint
The hip must bear the full force of your weight and consists of two main parts:
A ball (femoral head) at the top of your thigh bone (femur)
A rounded socket (acetabulum) in your pelvis

40. How’s this for an endorsement?
“The Operation of the Century:
Total Hip Replacement”
The Lancet, October 2007

41. Total Hip Replacement

42. Replaced Hip X-ray

43. Your Knee Joint Femur – thigh bone
Cartilage – tissue between bones that provides cushioning
Patella – knee cap
Tibia – shin bone
Synovium – tissue surrounding the joint that provides lubricating fluid
Ligament – flexible tissue that holds knee joint together

44. What Causes Knee Joint Pain?
One of the most common causes of joint pain is arthritis. The most common types of arthritis are:
Osteoarthritis (OA)
Rheumatoid Arthritis (RA)
Post-traumatic Arthritis

45. Total Knee Replacement
End surface of femur replaced with metal
End surface of tibia replaced with metal
Plastic liner is inserted between femur and tibia
Patella is resurfaced with plastic

46. Replaced Knee X-ray
Anterior (front) View
Lateral (side) View

47. Knee Replacement: Total versus Unicompartmental
Majority of patients predominantly affected in one compartment only
Relatively easier recovery
Less surgery
Maintain cruciate ligaments
“feels more natural”
Does not preclude TKA later
Most do not need to be converted

48. Computer Navigation
No benefit in skilled hands for the average patient
May help surgeon who do less joint replacements, but need to know when not to trust it…
Definitely helpful in outliers:
Significant deformity or malalignment
Old hardware
Total knee replacement is primarily a Soft Tissue Procedure.

50. Recovery

51. Recovery
Every individual is different and every treatment plan is different.
“You’ll be mad at me for two weeks”
Estimated Recovery Schedule:
In-hospital: 2 – 5 days
Significant Functional Improvement: 2 wks – 3 mos
Maximal Improvement: 6 – 12 months

52. Recovery Directed exercise program
The physical therapist or another member of the staff works with you to help you:
Regain muscle strength
Increase range of motion
Start with home PT and progress to outpatient therapy

53. General Guidelines to get back to your Routine
You'll practice stair-climbing in the hospital and should be able to do this by the time you leave
You should have no restrictions on leaving your home as long as your safety and comfort are assured. A good balance of exercise, rest, and relaxation is best for helping your body heal and gain strength
When to resume driving a car, going to work, and/or participating in sports activities are all highly individualized decisions.

54. Limitations After Surgery
Athletic activities that place excessive stress on the joint replacement should be avoided.
Examples include:
Difficult Skiing (snow or water)
Contact sports
Regular running
Frequent jumping
Patients don’t listen to me…

55. “Doc, how long will it last?”
Impossible to predict for an individual.
Many factors determine the outcome including:
Age
Weight
Activity level
Bone strength
Materials are getting better all the time – many joints replaced today will last a lifetime.

56. Expert care in joint replacement when You need it.
“I look forward to personally helping patients get back to the active lifestyle they deserve!”
A Virginia native with fellowship training in Joint Replacement, Dr. Harris specializes in the latest advances in Adult Reconstruction, including minimally invasive and computer-assisted procedures.
Barton Harris, MD
Orthopaedic Surgeon
Fellowship-Trained in
Hip and Knee Replacement
Minimally Invasive and Tissue-sparing techniques
Direct Anterior Hip Replacement
Partial Knee Replacement
Custom Total Joint Replacement
Revision Total Joint Replacement
Expert care in
joint replacement
when You need it.
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